Image taken from Clinical Guide to Oral Diseases.
Nicotinic stomatitis affects the palate of chronic smokers (mainly pipe smoking), initially appearing as a diffuse reddened area that slowly progress to a white thickened and fissured lesion where inflamed, swollen, ducts of minor salivary glands are noted. The lesion is restricted on the posterior palate to rugae and is reversible as is disappeared with smoking cessation.
The pathogenesis of nicotinic stomatitis is based on the heating irritation effect with smoking on the palatal mucosa and minor salivary glands, while it is not related to tobacco ingredients or the patient’s age or gender. The effect of the released heat during smoking on the palate depends on the duration, severity and type of smoking, and is exacerbated by the frequent consumption of hot liquids.
What is/are the differences between nicotinic stomatitis and speckled leukoplakia:
- Although both lesions are related to smoking, the heat released with smoking is responsible for nicotinic stomatitis, while the tobacco products (carcinogens) are responsible for speckled leukoplakia.
- Speckled leukoplakia can be seen everywhere in the mouth in contrast with nicotinic stomatitis which is exclusively found on the posterior hard and soft palate.
- The red spots in nicotinic stomatitis are dilated, inflamed ducts, openings of minor salivary glands, while in speckled leukoplakia are attributed to atrophic dysplastic mucosa.
- Nicotinic stomatitis is a benign reversible reaction, while speckled leukoplakia shows dysplasia and has a high risk of malignant transformation.